Low carb high ketones confusion!

Hi Saz,

My understanding is that raised ketones is not a problem as long as your blood sugar levels are find. It means that the insulin is continuing to do its job and you're not putting yourself at risk.

When blood sugar rises and rises, and ketones are present that's when you go into DKA, which rings alarm bells with all nurses... basically means you're going to end up in hospital.

Hope that helps until someone more experienced in LCHF comes along.

Sam.

saz1902 said:

She said that it was perfectly fine to have high ketones- as long as my blood readings were good!

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The part I've quoted seems a bit dangerous to me, it's NEVER ok to have high ketones (high ketones is obviously subjective, your reading of 2 I wouldn't class as majorly worrying but certianly need bringing down, I think in DAFNE they consider anything under 3 as a "minor illness" when dealing with the sick day rules), regardless if you're blood sugar level is fine, I recently had glandular fever and my sugar levels were fine but my ketones were high, it was the most uncomfortable thing in the world to bolus 4 units of insulin when my sugar levels were reading 7.1 but it had to be done to control and lower my ketones. Have you done DAFNE? If so, follow your sick day rules for dealing with ketones.

edit: Forgot to add, there's a thing called "starvation ketones" which you can get when you're not eating, so not sure if this may be linked to low carbing? Anyway, they way to deal with these is to get some carbs down you and bolus as normal for them, that should lower your ketones in that specific situation.

When low carbing you need ketones. Ketones are sort of the whole point. Low carb, normal bg, ketones around 1-3. Few would deem 2 as high ketones, would they? I think it sounds perfect.

As Totto said above, ketones are a by-product of fat burning and a reading of 2 wouldn't be considered a huge worry, (from a purely personal standpoint I wouldn't want ketones that high), but alas it can be dangerous for a type 1 diabetic, which is why I think I'm right in saying diets such as Atkins are not recommended for us.

I've been showing as high as ++++ on the ketostix at times over the last couple of years with no ill effects simply due to my LCHF diet,however,as an insulin user myself I DO take them seriously if my BG is elevated,say above 12 and/or I'm unwell.

This is a serious problem in diabetes. When you don't have enough insulin circulating your blood sugar becomes elevated. Since your body now has no way to use glucose, it starts breaking down fats as an alternative energy source. This causes ketones to build up in the blood which is toxic. If they test your urine they can see if you are dropping large ketones.

If you are not on insulin, low ketone readings are not an issue, especially if your BG is not elevated. Low ketone readings are normal if you're following a LCHF diet. Dr Stephen Phinney explains it in this video:

Do some reading up on the difference between (diabetic) ketoacidosis which can be very dangerous (mainly I believe for type 1s), and dietary/nutritional ketosis which is what happens and is quite natural when you are eating a low carb high fat diet. In this case your body goes into fat burning mode and produces ketones which it uses for energy instead of carbohydrates, and this is what you're aiming for particularly when you're trying to lose weight. There is apparently a lot of confusion over these two different ketone states!

To lower your ketone levels you'd need adjust your ratios of carbs and fat, so less fat and possibly more carbs. But I'm type 2 and so I don't know how high a type 1s ketone levels can go in ketosis to keep safe, if your glucose levels are OK, but hopefully ( @shedges ) Sam's post has reassured you.

Robbity

Type 1's are really only told to test for ketones if going out of target ranges.. (4-8). Really recommended if above 12bg to test as this with bg levels that start to seriously rise is dka.
Apart from that as I understand if in normal range, low carbing and ketones show from diet.. Then no prob..

Yeah there is huge confusion between ketosis and ketoacidosis. Think of ketones and blood sugars in a similar way; you can have some in your system and this is a very good thing. However, too much is dangerous. Some people believe you have to eat carbs to give your brain the power to function. This is incorrect. The brain can run beautifully on fat, and ketones are the result of the fat burning process. So long as you have sufficient insulin in your system, ketoacidosis should not be a danger.
Ketoacidosis results when the body is starved of the fuel it needs. Without insulin, the cells in your body cannot take glucose out of your blood to use as fuel. Therefore you are effectively starving. The body tries to get any form of fuel it can, so it burns its fat stores, producing ketones. However, without insulin the cells still can't get their energy, so more and more ketones are produced, creating massive levels in the blood; ketoacidosis.
So you might think 'But if glucose is so important to my cells, why would I want to cut it out by eating low carb?' The wonderful thing is, low carbing is not cutting out glucose at all. The body can also convert protein into glucose, but it does it more slowly through a process called gluconeogenesis. The ratio of conversion varies from person to person, but some low carbers work on the basis that 50% of the protein they eat will be converted into glucose. Because it does it more slowly, it makes it easier for your insulin (naturally produced for type 2s, injected for type 1s) to match the rise in glucose levels and stop blood sugars rising significantly. In the meantime, the body mobilises its fat stores, producing ketones to fuel the body. Because your cells are getting the fuel they need, you will not overproduce ketones, so ketoacidosis should not occur as long as your blood sugars are in a normal range.
Hope that helps.

donnellysdogs said:

Type 1's are really only told to test for ketones if going out of target ranges.. (4-8). Really recommended if above 12bg to test as this with bg levels that start to seriously rise is dka.
Apart from that as I understand if in normal range, low carbing and ketones show from diet.. Then no prob..

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It;s also important to test when ill. If you are vomiting or have diarrhoea and continuing to take insulin then levels can be reasonably low. However because the liver is depleted of glycogen ketones are produced and because of the fluid loss they can reach higher concentration. This can, albeit rarely, be sufficient to lead to acidosis ie DKA Normalglycemic or euglycemic DKA can also sometimes happen in pregnancy .
http://www.pjms.com.pk/issues/janmar08/article/bc2.html
That's one reason that people who are vomiting and can't keep anything down and have ketones are told in the UK to get medical advice

( I'm not advocating it because it's obviously a difference but I actually have a bit in my protocol about sipping sugary drinks ie flat cola if below 150mg/dl , coupled with specified amounts of insulin when sick with ketones present . This doesn't seem to form part of DAFNE sick day rules I notice )

The ketones produced in a low carb diet are absolutely no different to the ketones produced in DKA. It is the amount ie the concentration in the blood that leads to acidosis.

Indy51 said:

Low ketone readings are normal if you're following a LCHF diet.

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Yes, that's how an LCHF diet works. LCHF diets are also called ketogenic diets, because ketones are produced and metabolised by your body *instead* of blood glucose, of which there is less because of limited carbohydrate and only slow conversion from protein. There is nothing harmful about this - it's an alternative way the body has to fuel itself. And remember, our bodies can't handle carbohydrates - that's the whole point.

So long as your BS is under control and not regularly over, say, 12, you CANNOT develop ketoacidosis. It is high BS **plus** high ketones that should ring the alarm bells. So long as you are monitoring BS and it's low, you are not in any danger of acidosis from eating LCHF.

I was very worried about this in the early days because I'd been given misleading advice, until I calmed down and did some reading. Then I realised that ketogenesis and ketoacidosis are often confused.

Just keep checking your blood. And to understand the whole picture, I really recommend Jenny Ruhl's book, http://www.amazon.co.uk/gp/aw/d/B0080JVKMK?pc_redir=1412683185&robot_redir=1. It's very clear and well written and after reading this I understood the whole metabolism thing for the first time.

Good luck!

- Unless you're sick, or vomiting - then everything changes - take your ketones seriously and get help.